John Andrew Wagoner

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

R-12603 Issued in IA

Practice address

1801 Hickman Rd
Des Moines, IA 50314-1548

Phone

(151) 528-2854

NPI assigned

Jun 6, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Broadlawns Medical CenterGroup PAC ID 3678466166, 302 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Broadlawns Medical Center Hospital, Des Moines, IA, CCN 160101

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: john.wagoner.1@11667.direct.athenahealth.com
• Direct secure messaging: wagoner.john@cynchealthdsm.org
• Direct secure messaging: jwagoner887283@direct.unitypoint.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Broadlawns Medical Center

  • General Acute Care Hospital
  • Des Moines, IA
  • NPI 1467447508
  Medicare reassignment Care Compare group NPD
• Broadlawns Medical Center

  • Pharmacy
  • Des Moines, IA
  • NPI 1013197060
  NPD
• St Luke'S Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Broadlawns Medical Center

  • General Acute Care Hospital
  • Des Moines, IA
  • NPI 1467447508
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1528797743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 HICKMAN RD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503141548",
            "telephone_number": "151-528-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 HICKMAN RD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503141548",
            "telephone_number": "151-528-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "JOHN",
        "middle_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-06",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "R-12603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Ann Wagaman, D.O.
• Brooke Wagner
• Cameron Wagner, MD
• Felica Wagner
• Stacy Marie Wagner, D.O.
• Theresa Marie Wahlig, M.D.
• Joshua James Waits
• Wal-Mart Stores, Inc.
• Brianna Waldorf
• Elaine A. Waldschmitt, RD, LD, CDE

• Psychiatry Physician in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Psychiatry Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.